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Oana Albai and Romulus Timar

The Relationship Between 1 Hour Glycemia, During Oral Glucose Tolerance Test and Cardiometabolic Risk

Background Diabetes mellitus is a very common disease, worldwide there are currently over 366 million diabetics. It seems that people with normal glucose tolerance and blood glucose at 1 hour during OGTT ≥200mg% represent an intermediate phenotype of abnormal glucose metabolism, another disturbance of carbohydrate metabolism that is associated with increased cardiometabolic risk. Objectives Starting from these premises, we decided to analyze the subjects with glucose at 1 hour during OGTT ≥200mg%, but with normal values for fasting glucose and 2 hours glucose. In this subgroup of subjects some parameters of CMR were analyzed. We also performed a comparison of this subgroup of subjects with both normal glucose tolerance and 1-hour glucose <200mg%, and with those with abnormal glucose tolerance. Results According to currently used recommendations to diagnose diabetes mellitus, from the 778 people included in this study, 167 (21.5%) had disturbances of carbohydrate metabolism, being classified as patoglycemic and 611 persons (78.5%) had normal values of fasting glucose and 2 hours glucose during OGTT, being considered normoglycemic. From the 611 people who were classified as normal glucose tolerance, based on the currently used criteria for diagnosis of diabetes mellitus, a total of 44 persons (7.2%) had, however, the value of 1-hour glucose during OGTT ≥200mg%, which represents 5.6% of the entire group studied. Conclusions Patients with normal glucose tolerance and glucose ≥200mg% at 1 hour during OGTT represent a new subgroup of impaired glucose tolerance, which requires strict lifestyle advice and possibly pharmacological measures to prevent or delay progression to abnormal glucose tolerance.

Open access

Alin Albai, Romulus Timar, Bogdan Timar, Corina Hogea, Adrian Vlad, Oana Sdic, Ilie Cristina and Oana Albai

Abstract

Background and aims: Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with increased risk of maternal and fetal complications. The aim of this study was to examine and to compare pregnancy outcomes between women with T1DM and a control group of non diabetic women. Material and method: The present study included all pregnancies in T1DM women followed at Diabetes Clinic, Emergency County Clinical Hospital, Timişoara, from 1990 to 2010. Results: We found a relative risk of spontaneous abortions of 1.85 (95%CI 1.01-3.39; p=0.05) and a relative risk of major congenital malformations of 4.32 (95%CI 1.55-12; p=0.005) in T1DM pregnancies compared to the control group. We also observed that the rate of stillbirth was more frequent in type 1 diabetic pregnancies (p=0.02). The offspring of T1DM women were more likely to be delivered preterm (32%) compared with the control group (9.5%). The relative risk of preterm delivery was 3.38 higher (95%CI 2.93-5.6; p<0.0001) in T1DM pregnancies compared with non diabetic mothers. There was a statistically significant difference in the proportion of macrosomic offspring between T1DM (17.3%) and non diabetic mothers (6.5%) Conclusions: The present study demonstrated that pregnancy outcome and perinatal complications are still high in T1DM pregnancies.

Open access

Bogdan Timar and Oana Albai

Abstract

Background.Hyperglycemia is leading to serious chronic and acute complications in diabetes mellitus which are shortening and altering the patient’s life. Objective. The main purpose of the study is to investigate the correlation between HbA1c values and diabetic complications. Material and methods.The study enrolled 2120 diabetic patients, 1174 women (55.4%) and 946 men (44.6%), mean age 58.3 ± 12.3 years, living in Timisoara. Results.We observed the lowest incidence of chronic complications of diabetes mellitus for the group having HbA1c values lower than 6%. Chronic complications are increasing with the HbA1c value, with a significant threshold at 7 % (p<0.0001). Conclusions.Optimizing glycemic control is the key to prevent or delay the occurrence of severe chronic complications of diabetes mellitus, complications which can be significantly reduced by achieving the ADA recommended HbA1c target (<7%).

Open access

Oana Albai, Bogdan Timar, Laura Diaconu and Romulus Timar

Abstract

Objective: Despite the diversity of antidiabetic medication currently available, less than half of the patients with type 2 diabetes meet the therapeutic targets recommended by the guidelines: HbA1c <7%, or even <6.5%. This study aimed to investigate the efficacy and safety of sitagliptin in patients with type 2 diabetes mellitus, with inadequate glycemic control, as well as the effects on cardiovascular risk factors. Material and method: The study included 348 patients, 161 men (46.3%) and 187 women (53.7%), with mean age of 56.1 ± 6.2 years, who started treatment with sitagliptin, combined with either metformin, sulphonylurea or both. Results and discussions: Sitagliptin improved glycemic control reducing average HbA1c with 1.1%; the average weight decreased with 1.7 kg after 24 weeks of treatment, and the lipid profile improved significantly. Conclusions: Sitagliptin offers a new therapeutic option in patients with type 2 diabetes mellitus, with the advantage of a single dose oral administration.

Open access

Oana Albai, Bogdan Timar, Deiana Roman and Romulus Timar

Abstract

Background and aims Diabetes mellitus (DM) is one of the leading causes of end-stage chronic kidney disease (CKD). Patients with DM and CKD have a 10 or even 20 times higher cardiovascular risk (CVR) than the general population. Lipid metabolism disorders are more frequent in these patients, dyslipidemia being aggravated by the presence of hyperglycemia and insulin resistance. The main purpose of our study was to identify possible correlations between lipid profile parameters and altered renal function in patients with DM. We have also analyzed the correlations between lipid parameters, CKD, quality of glycemic control and CVR.

Material and method: The study was performed on 2732 patients with DM which received medical treatment and care at the Center for Diabetes Timisoara, for a 6-month period from March to October 2016, 1508 women (55.2%) and 1224 men (44.8%), mean age 63.7 ± 9.1 (33-78) years and mean diabetes duration 12.4 ± 6.8 (6-33) years. The study group included 312 patients (11.4%) with T1DM and 2420 patients (88.6%) with T2DM.

Results: The prevalence of CKD (GFR< 60 ml/min) was 12.5%. The levels of total cholesterol (TC), triglycerides (TG) and LDLc were significantly higher in the case of patients with DM and CKD (p<0.0001). Patients with CKD had twice the prevalence of ischemic heart disease and cerebrovascular disease when compared to patients without CKD. Peripheral artery disease was present in 16.9% of those with CKD and in 11% of those without CKD. Hypertension (HTN) was present in 91.8% of patients with CKD and in 67.1% of patients without CKD (GFR > 60 ml/min).

Conclusion: Analyzed data showed a strong correlation between CKD, dyslipidemia and CVR in patients with DM. Impaired renal function was strongly correlated with age, duration of DM and weight status of these patients.

Open access

Alin Albai, Viorel Șerban, Romulus Timar, Adrian Vlad, Bogdan Timar, Cristina Ilie and Oana Sdic

Abstract

Background and aims: A precarious glycemic control in the first 10 weeks of pregnancy, the period defining organogenesis, increases the risk of pregnancy loss. The aim of this study was to estimate the relationship between pregnancy loss and HbA1c values in early pregnancy in type 1 diabetic women.Material and method: The present study included all pregnancies in type 1 diabetic women followed at Diabetes Clinic, Emergency County Clinical Hospital, Timişoara, from 1990-2011. Results: The risk of pregnancy loss was significantly increased compared with the background control group. In our study the relative risk of pregancy loss increased when HbA1c exceeded 6.5%. We found a consistent increasing risk with stepwise increasing levels of HbA1c. Conclusions: A better glycemic control in this period and throughout the pregnancy could reduce the risk of severe adverse outcomes in type 1 diabetic pregnancies.